Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Sunday, May 31, 2015

Three Major Controversies in Neurology: A Debate - Stem Cell Clinical Trials: Nay

Overall the neurologists said nay.
http://www.medscape.com/viewarticle/844694_3

Cleveland Clinic - Stroke: Am I at Risk?

I can guarantee that you will just hear about the generic stuff, with no links to research
Here are my ideas on stroke prevention: Never, ever follow me.
Like my 11 Stroke risk reduction ideas.
I'm sure absolutely  none of these will be discussed.

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We have many exciting live online web chats scheduled for June. Take advantage of this rare opportunity to chat live with Cleveland Clinic physicians in a secure online setting.
Stroke: Am I at Risk?
Stroke is the fifth leading cause of death in the United States, killing nearly 130,000 Americans each year. While some risk factors can't be controlled like heredity, age and gender, there are other ways to prevent becoming part of this statistic. Join us to learn more about risk factors and preventative measures from a Cleveland Clinic Florida stroke expert.
Date: Tuesday, June 30, 2015
Time: 12:00 PM (EST)

You Wisdom Shall Always Keep You From Danger

Hah, my fortune cookie today

Saturday, May 30, 2015

Joni Mitchell Suffered Brain Aneurysm, Making Speech Difficult As She Enters Rehab

A normal aneurysm would just balloon out a little bit so this must have been a whopper to affect the surrounding neurons. Or is this title totally wrong and she had a hemorrhage? The aneurysm burst?
http://www.inquisitr.com/2130419/joni-mitchell-suffered-brain-aneurysm-making-speech-difficult-as-she-enters-rehab-fans-send-weloveyoujoni-prayers/
Joni Mitchell had a brain aneurysm that resulted in a grim prognosis for the famous singer. Sources say that the 71-year-old’s recovery has been long and shaky, reported MSN.
Mitchell’s health crisis began on March 31 when she was discovered unconscious at home. After hospitalization, her exact health and future still is relatively unknown.
“Speech is difficult,” said one source, “but she’s communicating.”
Another insider described Joni’s condition as “very serious.”
However, Mitchell has been moved to a rehab facility to continue her recovery, according to Showbiz.
It is known that she did not have a stroke and that Joni’s friend Leslie Morris hopes to set up a home rehab situation so that Mitchell can be more comfortable in familiar surroundings.

Coordinating neurons with blood vessels

We need this for both neurogenesis and stem cells. What is your doctor doing to follow up on this line of therapy? It may not help us in time but future survivors will need this.
http://www.sciencemag.org/content/348/6238/986.1.full?
Science
Vol. 348 no. 6238 p. 986
DOI: 10.1126/science.348.6238.986-a                        


Figure
Neurons and blood vessels in the retina
PHOTO: THOMAS DEERINCK/NCMIR/SCIENCE SOURCE

The retina develops as interleaved layers of neurons and blood vessels. Usui et al. show that in mice, the development of blood vessel layers depends on signals from amacrine cells, a type of interneuron in the retina. Too much or too little signal resulted in too many or too few blood vessels, particularly affecting the intermediate vascular plexus (a network of blood vessels) embedded within the retina. This cellular crosstalk coordinates neuronal demand for oxygen with the blood's ability to supply it. With the intermediate vascular plexus poorly formed, photoreceptors (a type of neuron) degenerate, leading to deficits in vision.
J. Clin. Invest. 10.1172/JCI80297 (2015).                                    

Statin Drug Muscle Pain: What Cholesterol Patients Should Know

And while you're at it you can have your doctor explain away these other 45 posts I've written on statin side effects Don't listen to me, I have no medical training and obviously should never question our doctor gods.
Statin Drug Muscle Pain: What Cholesterol Patients Should Know

Smuggling Drugs into the Brain: An Overview of Ligands Targeting... (2015)

Whenever we do find drugs to deliver we will need this.
http://www.narcis.nl/publication/RecordID/oai:pure.rug.nl:publications%2F661e6d46-d085-4a85-a214-7f400e9a8c8d
Published inPharmaceutics, Vol. 6, No. 4, p.557-83.
AuthorZuhorn, Inge; Georgieva, Julia V.; Hoekstra, Dick
PublisherCenter for Liver, Digestive and Metabolic Diseases (CLDM); Nanobiotechnology and Advanced Therapeutic Materials (NANOBIOMAT); Molecular Neuroscience and Ageing Research (MOLAR)
Date2015
LanguageEnglish
TypeArticle
AbstractThe blood-brain barrier acts as a physical barrier that prevents free entry of blood-derived substances, including those intended for therapeutic applications. The development of molecular Trojan horses is a promising drug targeting technology that allows for non-invasive delivery of therapeutics into the brain. This concept relies on the application of natural or genetically engineered proteins or small peptides, capable of specifically ferrying a drug-payload that is either directly coupled or encapsulated in an appropriate nanocarrier, across the blood-brain barrier via receptor-mediated transcytosis. Specifically, in this process the nanocarrier-drug system ("Trojan horse complex") is transported transcellularly across the brain endothelium, from the blood to the brain interface, essentially trailed by a native receptor. Naturally, only certain properties would favor a receptor to serve as a transporter for nanocarriers, coated with appropriate ligands. Here we briefly discuss brain microvascular endothelial receptors that have been explored until now, highlighting molecular features that govern the efficiency of nanocarrier-mediated drug delivery into the brain.
Publicationhttps://www.rug.nl/research/portal/en/publications/smuggling...

Sequential Therapy with Minocycline and Candesartan Improves Long-Term Recovery After Experimental Stroke

Is this enough to start up human clinical trials? Ask your doctor and if your doctor doesn't do clinical trials you need to call the hospital president and ask why the stroke department head isn't solving stroke problems by doing clinical research.
http://link.springer.com/article/10.1007/s12975-015-0408-8

Sahar Soliman,







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Abstract

Minocycline and candesartan have both shown promise as candidate therapeutics in ischemic stroke, with multiple, and somewhat contrasting, molecular mechanisms. Minocycline is an anti-inflammatory, antioxidant, and anti-apoptotic agent and a known inhibitor of matrix metalloproteinases (MMPs). Yet, minocycline exerts antiangiogenic effects both in vivo and in vitro. Candesartan promotes angiogenesis and activates MMPs. Aligning these therapies with the dynamic processes of injury and repair after ischemia is likely to improve success of treatment. In this study, we hypothesize that opposing actions of minocycline and candesartan on angiogenesis, when administered simultaneously, will reduce the benefit of candesartan treatment. Therefore, we propose a sequential combination treatment regimen to yield a better outcome and preserve the proangiogenic potential of candesartan. In vitro angiogenesis was assessed using human brain endothelial cells. In vivo, Wistar rats subjected to 90-min middle cerebral artery occlusion (MCAO) were randomized into four groups: saline, candesartan, minocycline, and sequential combination of minocycline and candesartan. Neurobehavioral tests were performed 1, 3, 7, and 14 days after stroke. Brain tissue was collected on day 14 for assessment of infarct size and vascular density. Minocycline, when added simultaneously, decreased the proangiogenic effect of candesartan treatment in vitro. Sequential treatment, however, preserved the proangiogenic potential of candesartan both in vivo and in vitro, improved neurobehavioral outcome, and reduced infarct size. Sequential combination therapy with minocycline and candesartan improves long-term recovery and maintains candesartan’s proangiogenic potential.

Understanding Persuasion and Motivation in Interactive Stroke Rehabilitation

Your doctor needs to know which patients need motivation to undertake the extremely difficult task of stroke rehab with absolutely no guidebook and no help from the doctor. Or you'll have to get this yourself.
http://link.springer.com/chapter/10.1007/978-3-319-20306-5_2
Michelle Pickrell,


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Abstract

For the research reported in this paper ethnographic research methodologies were used to explore patient motivation, feedback and the use of interactive technologies in the ward. We have conducted in-depth interviews with physiotherapists, who work closely with stroke patients to help them regain movement and function. From this research, a set of design guidelines have been developed which can be applied in the design of interactive rehabilitation equipment.

Effects of Microglia on Neurogenesis

Your doctor needs to know how to create neurogenesis in your brain so send her after this article.
http://onlinelibrary.wiley.com/doi/10.1002/glia.22858/full

Author Information

  1. Division of Pharmacology, Laboratory of Neuropharmacology, National Institute of Health Sciences, Setagaya-Ku, Tokyo, Japan
*Address correspondence to Kaoru Sato, Division of Pharmacology, Laboratory of Neuropharmacology, National Institute of Health Sciences, Kamiyoga 1-18-1, Setagaya-ku, Tokyo 158-8501, Japan. E-mail: kasato@nihs.go.jp
  • Abstract

  • Keywords:

    • microglia;
    • subventricular zone;
    • subgranular zone;
    • neurogenesis;
    • cytokine
    This review summarizes and organizes the literature concerning the effects of microglia on neurogenesis, particularly focusing on the subgranular zone (SGZ) of the hippocampus and subventricular zone (SVZ) of the lateral ventricles, in which the neurogenic potential is progressively restricted during the life of the organism. A comparison of microglial roles in neurogenesis in these two regions indicates that microglia regulate neurogenesis in a temporally and spatially specific manner. Microglia may also sense signals from the surrounding environment and have regulatory effects on neurogenesis. We speculate microglia function as a hub for the information obtained from the inner and outer brain regions for regulating neurogenesis. GLIA 2015

    Blue Cross Blue Shield Continues To Block Coverage for Biofeedback and Neurofeedback

    You may have to fight for coverage. I've only written 15 posts on biofeedback and 8 on neurofeedback already but this link probably has better support for getting it approved. If we had decent stroke associations they would be fighting for this intervention but I bet they aren't doing anything.
    http://www.bmedreport.com/archives/3095

    Friday, May 29, 2015

    Physical coffee rehab

    To get my quota of daily coffee at work I have to be able to use this style of lever press pot with my spastic left arm. As long as no one is standing to the left of me I can do this, it looks awful, the synergies involved are every single muscle in my arm, hand, left leg, and left side core. The main problem is that only getting 3-4 cups a day does not count as high repetitions. The other style of press pot with the plungeable button I can't use. I can't coordinate my fingers into a tight enough circle to press the button down. There is absolutely no way I can put a coffee cup(hard or disposable) into the left hand and have any hope of success. The disposable ones would be immediately crushed, the hard ones would tip to the right from spasticity. This is an important ADL, as such there should be a effective stroke protocol for this recovery.
    lever press - useable
    Button press - not useable
     

    A Cup Of Coffee Is Healthy, But 4 Isn't: EU Guidelines Suggest New Limit To Daily Intake

    Well this is for healthy people so it obviously does not apply to me, and I'm not in the EU. I haven't been healthy for over 9 years.
    http://www.medicaldaily.com/cup-coffee-healthy-4-isnt-eu-guidelines-suggest-new-limit-daily-intake-335486

    Creativity Tied to Cerebellum for First Time

    For you cerebellar strokes out there your doctor will need to come up with a stroke protocol to fix your creativity.
    http://www.biosciencetechnology.com/articles/2015/05/creativity-tied-cerebellum-first-time?

    A stress assessment that generates a “stress number” gets Mayo Clinic support

    Your doctor should be able to quantify your stress levels and provide a protocol to combat it. Does s/he even know your chance of  PTSD following stroke is 23%?
    http://medcitynews.com/2015/05/a-stress-assessment-that-generates-a-stress-number-gets-mayo-clinic-support/?

    Cheetah robot lands the running jump

    We've got the brains out there to solve all the problems in stroke. We just need a great stroke association to challenge those brains to solve these problems. But this won't occur because our stroke associations believe their highest calling is putting out press releases.
    http://www.rdmag.com/videos/2015/05/cheetah-robot-lands-running-jump?

    EMS1 Poll Results: How do you assess and treat stroke?

    The results of this should lead immediately to a training program put together by the ASA and NSA to make sure all strokes are treated appropriately  on the way to the hospital. What is your hospital doing to make sure their EMS responders are properly trained?
    http://www.ems1.com/ems-products/Ambulance-Disposable-Supplies/articles/2179388-EMS1-Poll-Results-How-do-you-assess-and-treat-stroke

    Device to restore balance for stroke victims is getting on its feet

    Which balance intervention would be the best for stroke survivors? Which ones is your hospital evaluating? Do you even have a stroke protocol to recover balance?

    1.  First study on the effects of unstable shoes with curved soles on trunk muscles and lumbar lordosis 

    2. Feasibility of Delivering a Dance Intervention for SubAcute Stroke in a Rehabilitation Hospital Setting 

    3.  Easy exercises to improve stability and prevent falls

    4.  Simple, everyday activities can strengthen balance

    5.  Longitudinal Analysis of Balance Confidence in Individuals With Stroke Using a Multilevel Model for Change

    6.  Clinical Correlates of Between-Limb Synchronization of Standing Balance Control and Falls During Inpatient Stroke Rehabilitation

    7.  New framework for rehabilitation – fusion of cognitive and physical rehabilitation: the hope for dancing

    8.  Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review

    9.  Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training

    10.  Walking on ice takes more than brains - Salk scientists discover how a "mini-brain" in the spinal cord aids in balance

    11.  Iranian robot helping restore balance in stroke patients

    12.  Protocol for a randomized controlled clinical trial investigating the effectiveness of Fast muscle Activation and Stepping Training (FAST) for improving balance and mobility in sub-acute stroke

    13.  Sailing as Stroke Rehabilitation Strategy

    14.  Shoes that bounce - KANGOO aerobics

    15.  Chase your stroke recovery by drinking

     16.  Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the first half decade of "Wii-search"

    17.  Lifestyle-integrated Functional Exercise - Reducing falls and improving function

     ------------------------------------------------------------------------------------

     And the latest here:

    Device to restore balance for stroke victims is getting on its feet

    About 800,000 Americans suffer from a stroke each year. This is an increase from years past due to the ever-aging demographics of America. Not only are there more strokes each year, strokes are now more survivable than before thanks to advances in technology and medicine. Each year, the population of stroke survivors increases, creating a growing and underserved market.

    Strokes are notorious for causing long-term disability including forms of paralysis, memory loss and constipation. Post stroke, about 90 percent of patients require a form of rehab; many of these rehab methods are now being deemed “inadequate” for fully rehabilitating a patient.

    Traditional methods of rehabilitation revolve around what is known as gait therapy. Gait therapy is the rehabilitation of a patient’s walking ability post-injury or disability. One of the go-to pieces of equipment for gait therapy has been the treadmill, but treadmills lack the dynamic ability to rehab a patient’s sense of balance so that they may correctly walk. In order for a stroke patient’s balance to be rehabbed, the neuromuscular pathways need to train.

    KIINCE (pronounced KEAN-say) is a start-up company developing equipment specifically to rehabilitate a person’s sense of balance. The ideas and patented technology of KIINCE have advanced to the final round of the Wisconsin Governor’s Business Plan Contest, which will conclude June 2-3 at the Wisconsin Entrepreneurs’ Conference in Madison.

    Patrick Walters, one of the company’s co-founders and CEO, has worked with Dr. Kreg Gruben on the project. Gruben is a UW-Madison neuro-mechanics researcher and is the chief scientist and primary founder of KIINCE. Gruben is also an engineer and inventor who has invested decades of research into KIINCE’s technology.

    “There’s a sizeable market that needs attention and current products aren’t fulfilling their promise, but Dr. Gruben’s technology can do so,” Walter said.

    KIINCE’s technology is based on Gruben’s research on neuromuscular pathways and balance. Rather than develop a piece of rehab equipment that focuses on the motion of walking, Gruben’s “KIINCE Machine” emphasizes rebuilding neuro-pathways to repair a patient’s sense of balance.

    “Think about spinning around in a circle and being able to quickly orient yourself; it means you have a healthy neuromuscular pathway,” Walters said. “If you’ve had a stroke or traumatic brain injury, (KIINCE) now has the ability to retrain these pathways in your brain.”

    The device is an all-in-one system consisting of hardware, the instrumented foot- plates, sensors, and patient monitor as well as software (the feedback loop) that drives the foot-plate motion and guides the patients walking pattern, Walters explained.

    The KIINCE Machine is undergoing the early stages of clinical trials at several rehabilitation centers in Wisconsin but looks to expand into others soon.

    “The KIINCE device fits the portfolio for healthcare investment groups,” Walters said and “the medical devices of KIINCE appear attractive to investors.”

    According to Walters, KIINCE also has three more minimally viable product agreements pending with three more clinics. Within the clinics the KIINCE machines would see large scale use, helping the company to further grow.

    KIINCE’s growth aims to affect not only the well-being of stroke patients but Madison’s economy. Walters estimates that within three to five years KIINCE could generate up to 40 jobs in the Madison area.

    “These would be high-paying jobs and not the usual salary position jobs,” Walters stated. “These are the type of jobs that would make a positive impact on the local economy.” However, in order to reach that level of job growth, Walters said the key is reaching the market of underserved stroke patients.

    “We will be able to reach these people when we’ve acquired our funding and reached our critical milestones,” he said.

    Scientists issue a call to action for TBI patients to benefit from latest neuroscience findings

    What scientists/doctors are issuing the same call to benefit stroke patients? If we had any stroke leaders at all this would have already occurred. But we have none.
    http://sharpbrains.com/blog/2015/05/15/scientists-issue-a-call-to-action-for-tbi-patients-to-benefit-from-latest-neuroscience-findings/

    To improve memory and thinking skills, try the Mediterranean diet with added olive oil and nuts

    Does your hospital have a Mediterranean diet for you and did you get EXACT instructions on how to create one at home? If not, why does your doctor not want to improve your memory and thinking?
    Do not do this by yourself, you know how dangerous a Mediterranean diet can be if you don't do it correctly.
    http://sharpbrains.com/blog/2015/05/21/study-to-improve-memory-and-thinking-skills-try-the-mediterranean-diet-with-added-olive-oil-and-nuts/

    Thursday, May 28, 2015

    Developing a Clinically Relevant Model of Cognitive Training After Experimental Traumatic Brain Injury

    What is the Clinically Relevant Model of Cognitive Training After Stroke?  Since we don't have one survivors are completely on their own doing dangerous cognitive training with no supervision. This may be in rats but we have to start somewhere.
    http://nnr.sagepub.com/content/29/5/483?etoc
    1. Samuel W. Brayer1
    2. Scott Ketcham1
    3. Huichao Zou, MD, PhD2
    4. Max Hurwitz1
    5. Christopher Henderson1
    6. Jay Fuletra1
    7. Krishma Kumar1
    8. Elizabeth Skidmore, PhD3
    9. Edda Thiels, PhD4
    10. Amy K. Wagner, MD2
    1. 1Department of Physical Medicine and Rehabilitation, University of Pittsburgh
    2. 2Department of Physical Medicine and Rehabilitation, Safar Center for Resuscitation Research, University of Pittsburgh
    3. 3Department of Occupational Therapy, University of Pittsburgh
    4. 4Department of Neurobiology, University of Pittsburgh
    1. Amy K. Wagner, Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Building, Suite 202, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Email: wagnerak@upmc.edu

    Abstract

    Background. Following traumatic brain injury (TBI), clinical cognitive training paradigms harness implicit and explicit learning and memory systems to improve function; however, these systems are differentially affected by TBI, highlighting the need for an experimental TBI model that can test efficacy of cognitive training approaches.  
    Objectives. To develop a clinically relevant experimental cognitive training model using the Morris water maze (MWM) wherein training on implicitly learned task components was provided to improve behavioral performance post-TBI.  
    Methods. Eighty-one adult male rats were divided by injury status (controlled cortical impact [CCI]/Sham), non-spatial cognitive training (CogTrained/No-CogTrained), and extra-maze cues (Cued/Non-Cued) during MWM testing. Platform latencies, thigmotaxis, and search strategies were assessed during MWM trials.  
    Results. Cognitive training was associated with improved platform latencies, reduced thigmotaxis, and more effective search strategy use for Sham and CCI rats. In the Cued and Non-Cued MWM paradigm, there were no differences between CCI/CogTrained and Sham/No-CogTrained groups. During novel testing conditions, CogTrained groups applied implicitly learned knowledge/skills; however, sham-cued CogTrained/rats better incorporated extramaze cues into their search strategy than the CCI-Cued group. Cognitive training had no effects on contusion size or hippocampal cell survival.  
    Conclusions. The results provide evidence that CCI-CogTrained rats that learned the nonspatial components of the MWM task applied these skills during multiple conditions of the place-learning task, thereby mitigating cognitive deficits typically associated with this injury model. The results show that a systematic application of clinically relevant constructs associated with cognitive training paradigms can be used with experimental TBI to affect place learning.



    Walking Speed and Step Length Asymmetry Modify the Energy Cost of Walking After Stroke

    Well, do I have enough energy to walk and talk at the same time? Inquiring minds want to know.
    From this your PT should be figuring out a way to get your walking more symmetric.
    http://nnr.sagepub.com/content/29/5/416?etoc
    1. Louis N. Awad, DPT1,2
    2. Jacqueline A. Palmer, DPT1,2
    3. Ryan T. Pohlig, PhD1,3
    4. Stuart A. Binder-Macleod, PhD1,2,3
    5. Darcy S. Reisman, PhD1,2
    1. 1Department of Physical Therapy, University of Delaware, Newark, DE, USA
    2. 2Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
    3. 3Delaware Clinical and Translational Research Accel Program, University of Delware, Newark, DE, USA
    1. Darcy Reisman, PhD, University of Delaware, 540 South College Avenue, Newark, DE 19713, USA. Email: dreisman@udel.edu

    Abstract

    Background. A higher energy cost of walking poststroke has been linked to reduced walking performance and reduced participation in the community.  
    Objective. To determine the contribution of postintervention improvements in walking speed and spatiotemporal gait asymmetry to the reduction in the energy cost of walking after stroke. Methods. In all, 42 individuals with chronic hemiparesis (>6 months poststroke) were recruited to participate in 12 weeks of walking rehabilitation. The energy cost of walking, walking speed, and step length, swing time, and stance time asymmetries were calculated pretraining and posttraining. Sequential regression analyses tested the cross-sectional (ie, pretraining) and longitudinal (ie, posttraining changes) relationships between the energy cost of walking versus speed and each measure of asymmetry.  
    Results. Pretraining walking speed (β = −.506) and swing time asymmetry (β = .403) predicted pretraining energy costs: adj R 2 = 0.713; F(3, 37) = 34.05; P < .001. In contrast, change in walking speed (β = .340) and change in step length asymmetry (β = .934) predicted change in energy costs with a significant interaction between these independent predictors: adj R 2 = 0.699; F(4, 31) = 21.326; P < .001. Moderation by the direction or the magnitude of pretraining asymmetry was not found. 
    Conclusions. For persons in the chronic phase of stroke recovery, faster and more symmetric walking after intervention appears to be more energetically advantageous than merely walking faster or more symmetrically. This finding has important functional implications, given the relationship between the energy cost of walking and community walking participation.

    Cortical Mechanisms of Mirror Therapy After Stroke

    WHO is going to finally write up a stroke protocol for using mirror therapy? Or do survivors have to do this dangerous therapy on their own?
    http://nnr.sagepub.com/content/29/5/444?etoc
    1. Holly E. Rossiter, PhD1
    2. Mimi R. Borrelli, MSc1
    3. Robin J. Borchert1
    4. David Bradbury1
    5. Nick S. Ward, MD1
    1. 1UCL Institute of Neurology, London, UK
    1. Holly Rossiter, UCL Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK. Email: h.rossiter@ucl.ac.uk

    Abstract

    Background and Objective. Mirror therapy is a new form of stroke rehabilitation that uses the mirror reflection of the unaffected hand in place of the affected hand to augment movement training. The mechanism of mirror therapy is not known but is thought to involve changes in cerebral organization. We used magnetoencephalography (MEG) to measure changes in cortical activity during mirror training after stroke. In particular, we examined movement-related changes in the power of cortical oscillations in the beta (15-30 Hz) frequency range, known to be involved in movement. Methods. Ten stroke patients with upper limb paresis and 13 healthy controls were recorded using MEG while performing bimanual hand movements in 2 different conditions. In one, subjects looked directly at their affected hand (or dominant hand in controls), and in the other, they looked at a mirror reflection of their unaffected hand in place of their affected hand. The movement-related beta desynchronization was calculated in both primary motor cortices.  
    Results. Movement-related beta desynchronization was symmetrical during bilateral movement and unaltered by the mirror condition in controls. In the patients, movement-related beta desynchronization was generally smaller than in controls, but greater in contralesional compared to ipsilesional motor cortex. This initial asymmetry in movement-related beta desynchronization between hemispheres was made more symmetrical by the presence of the mirror.  
    Conclusions. Mirror therapy could potentially aid stroke rehabilitation by normalizing an asymmetrical pattern of movement-related beta desynchronization in primary motor cortices during bilateral movement.

    Machine-Based, Self-guided Home Therapy for Individuals With Severe Arm Impairment After Stroke

    I would be willing to bet that the rowing based wheelchair propulsion would provide more repetitions than any other therapy. But hell it won't be applied because it changes the status quo.
    Rowing wheelchair

    http://nnr.sagepub.com/content/29/5/395?etoc
    1. Daniel K. Zondervan, PhD1
    2. Renee Augsburger2
    3. Barbara Bodenhoefer1
    4. Nizan Friedman, PhD1
    5. David J. Reinkensmeyer, PhD1
    6. Steven C. Cramer, MD1
    1. 1University of California at Irvine, CA, USA
    2. 2UC Irvine Medical Center, CA, USA
    1. Daniel Zondervan, PhD, Department of Mechanical and Aerospace Engineering, UC Irvine, 2402 Calit2 Building, Irvine, CA 92697, USA. Email: dzonderv@uci.edu

    Abstract

    Background. Few therapeutic options exist for the millions of persons living with severe arm impairment after stroke to increase their dose of arm rehabilitation. This study compared self-guided, high-repetition home therapy with a mechanical device (the resonating arm exerciser [RAE]) to conventional therapy in patients with chronic stroke and explored RAE use for patients with subacute stroke. Methods. A total of 16 participants with severe upper-extremity impairment (mean Fugl-Meyer [FM] score = 21.4 ± 8.8 out of 66) >6 months poststroke were randomized to 3 weeks of exercise with the RAE or conventional exercises. The primary outcome measure was FM score 1 month posttherapy. Secondary outcome measures included Motor Activity Log, Visual Analog Pain Scale, and Ashworth Spasticity Scale. After a 1-month break, individuals in the conventional group also received a 3-week course of RAE therapy. Results. The change in FM score was significant in both the RAE and conventional groups after training (2.6 ± 1.4 and 3.4 ± 2.4, P = .008 and .016, respectively). These improvements were not significant at 1 month. Exercise with the RAE led to significantly greater improvements in distal FM score than conventional therapy at the 1-month follow-up (P = .02). In a separate cohort of patients with subacute stroke, the RAE was found feasible for exercise. Discussion. In those with severe arm impairment after chronic stroke, home-based training with the RAE was feasible and significantly reduced impairment without increasing pain or spasticity. Gains with the RAE were comparable to those found with conventional training and also included distal arm improvement.

    Bill Gates once said, "Your most unhappy customers are your greatest source of learning."

     Matt Lopez, president of the NSA
     Dr. Mariel Jessup, president of the ASA
    WSO President - Steve Davis (Australia)
    Have any of you ever talked to any survivors at all about your services to survivors?
    I'm incredibly f*cking unhappy about what should be services to survivors from your organizations. 

    Thanks for your heroic effort! - American Stroke Association

    With no information on what they have actually done the past year they is no way they will be getting any money from me. Total failure. Dr. Mariel L. Jessup I expect better.

    Your American Stroke Month donation does a lot. It helps fund research(really? what?) and advances in stroke treatment. It also helps us teach more Americans to spot stroke F.A.S.T.
    Currently, only two out of three Americans can identify all the F.A.S.T. stroke warning signs, so your gift and its power to educate would-be stroke heroes might just make a life-or-death difference to someone you know. Or to you.

    Microbes Effect on the Brain

    This doctors' blog on this is too detailed to summarize so ask your doctor what is being done with this to adjust your stroke protocols for recovery.
    http://jonlieffmd.com/blog/microbes-effect-on-the-brain
    A couple selected sentences;
    Without microbes, there is a much higher level of stress steroids from the hypothalamus (corticosteroids) and a lower level of BDNF, (brain derived neurotrophic factor stimulates new neurons and brain connections).
    Mice without microbes have decreases in several important neurotransmitters and factors. BDNF is lower, which affects the development of new brain cells for memory. 
    Also, microbes make many other small molecules that can be neuro modulators or new neurotransmitters. This includes serotonin, dopamine, GABA, epinephrine, acetylcholine and others.
    Mice without microbes have decreases in several important neurotransmitters and factors. BDNF is lower, which affects the development of new brain cells for memory. - See more at: http://jonlieffmd.com/blog/microbes-effect-on-the-brain#sthash.O7jw4XzD.dpuf


    Without microbes, there is a much higher level of stress steroids from the hypothalamus (corticosteroids) and a lower level of BDNF, (brain derived neurotrophic factor stimulates new neurons and brain connections). - See more at: http://jonlieffmd.com/blog/microbes-effect-on-the-brain#sthash.O7jw4XzD.dpuf

    Evidence Based Medicine - stroke

    You'll have to ask your doctor where everything in your therapy recommendations falls. I assume anecdotes are at the lowest level and hopefully your doctors aren't using those as basis for your recovery.

    The inner engineer: One researcher’s quest to understand the brain

    A great stroke association would hire her immediately and put her in charge of  identifying research opportunities that need funding. But we have jackshit for stroke associations, only good for press releases.
    The inner engineer: One researcher’s quest to understand the brain
    For Jennifer Raymond, PhD, associate professor of neurobiology, the decision to devote her career to deciphering how the brain operates was, well, a no-brainer.
    “I think we’re all curious about how our brains work,” Raymond says in the video above. “It’s really fundamental to who we are.”
    She’s on a hunt for the brain’s “inner engineer,” the “actor” that decides how the brain should rewire itself to operate more efficiently. And now is a good time for the field, she says.
    In neuroscience, we’re poised to start making some fundamental breakthroughs in understanding how the building blocks of the brain, the neurons, work together to perform computations and to learn.
    Those insights will have big implications for society and medicine, Raymond says.
    If we can better understand how the brain learns, this will help us design better treatments for people with learning disabilities or people recovering from stroke…
    - See more at: http://scopeblog.stanford.edu/2015/05/28/the-inner-engineer-one-researchers-quest-to-understand-the-brain/#sthash.T0WIGAfc.dpuf
     For Jennifer Raymond, PhD, associate professor of neurobiology, the decision to devote her career to deciphering how the brain operates was, well, a no-brainer.

    “I think we’re all curious about how our brains work,” Raymond says in the video above. “It’s really fundamental to who we are.”

    She’s on a hunt for the brain’s “inner engineer,” the “actor” that decides how the brain should rewire itself to operate more efficiently. And now is a good time for the field, she says.

        In neuroscience, we’re poised to start making some fundamental breakthroughs in understanding how the building blocks of the brain, the neurons, work together to perform computations and to learn.

    Those insights will have big implications for society and medicine, Raymond says.

        If we can better understand how the brain learns, this will help us design better treatments for people with learning disabilities or people recovering from stroke…
    For Jennifer Raymond, PhD, associate professor of neurobiology, the decision to devote her career to deciphering how the brain operates was, well, a no-brainer.
    “I think we’re all curious about how our brains work,” Raymond says in the video above. “It’s really fundamental to who we are.”
    She’s on a hunt for the brain’s “inner engineer,” the “actor” that decides how the brain should rewire itself to operate more efficiently. And now is a good time for the field, she says.
    In neuroscience, we’re poised to start making some fundamental breakthroughs in understanding how the building blocks of the brain, the neurons, work together to perform computations and to learn.
    Those insights will have big implications for society and medicine, Raymond says.
    If we can better understand how the brain learns, this will help us design better treatments for people with learning disabilities or people recovering from stroke…
    - See more at: http://scopeblog.stanford.edu/2015/05/28/the-inner-engineer-one-researchers-quest-to-understand-the-brain/#sthash.T0WIGAfc.dpuf

    The Type of Smile That Helps Start New Relationships

    Your doctor or hospital psychologist should be helping you with this since you are probably going to lose lots of former friends and will need to create new ones.
    Aristotles' ideas on friendship are the most interesting. Post stroke I think I lost every utility and pleasure friend. The virtuous ones I retained, they were all college roommates from 37 years ago. We still get together quite often.
    http://cantory.blogspot.com/2007/12/aristotle-and-his-view-of-friendship.html
    But don't listen to me, I'm not medically trained and know nothing.

    The Type of Smile That Helps Start New Relationships

    duchenne smile photos

    Toenail

    This morning post shower the toenail just fell off. One day short of one month since separation. The past week the toe has been sending shooting pains and the foot would spasm. At least the new toenail looks good. Still the whole cruise and trip was worth it.

    The Statin Dilemma: a Primer for Patients

    When the most important part of atherosclerosis is not described correctly there is little confidence in the information. Cholesterol does not cause atherosclerosis. Inflammation grabs the particles floating by in the bloodstream and packs them into plaque.  We have been going about this all wrong for years, we went after secondary prevention by reducing cholesterol rather than looking at cause and effect. Stopping inflammation would make much more sense, but that won't occur now because statins are a huge profit center for the drug industry.
    Video here:
    Stopping the original inflammation that starts the process of plaque formation

     The Statin Dilemma: a Primer for Patients

    But never listen to me, ask your doctor these questions.

    Wednesday, May 27, 2015

    Is Dean angy?

    No, but  I am f*cking disappointed in the complete stroke medical world for not even trying to solve the problems in stroke. It is so easy to see what needs to be done that I can't believe there are that many stupid people working in stroke. I expect leaders to tackle problems rather than just issue press releases and tell us about F.A.S.T.  WHY ARE YOU WAITING FOR SOMEONE ELSE TO SOLVE THE PROBLEM?

    Study confirms coffee can make you happy

    I'm happy. Although they never do point to the actual study. Terrible reporting.
    http://www.stethnews.com/1016/study-confirms-coffee-can-make-you-happy/

    Your stroke hospital is putting on a stroke seminar - Questions to ask

    Four questions to ask of them:
    1. What is your 30-day death rate vs. the rest of the hospitals in the state?
    2. What is your 100% recovery rate?
    3.  What percentage of your tPA administration results in full recovery? Is it better than 12%?
    4. What are you doing in the first week to stop the neuronal cascade of death?
    Non answers should result in calling the hospital president to ask why they are so incompetent.
    They will do their damnedest to not answer and tell you useless crap like they follow ' Get With the Guidelines' or are certified by the Joint Commission.
    Bring them back to reality and demand they answer these questions. RESULTS ARE EVERYTHING!
    Or these will get assigned the:
    Big f*cking whoopee.

    Movies

    While in St. Paul for the weekend I saw two movies.
    Kingsman, great movie, I especially liked the exploding heads set to the William Tell Overture.
    Mad Max: Fury Road - completely awful, no plot at all, no reason to care for any of the characters.

    Stroke prevention app paves the way for world-first global study Internationally praised app Stroke Riskometer™

    Guargantuan F*cking Whoopee.
    This statement really means they have given up on actually helping survivors.  “A stroke is easier to prevent than treat.”  Leaders tackle the difficult problems. We have NO leaders in stroke.

    http://symbianone.com/2015/05/mobile-the-future-of-personal-medicine/
    Stroke Riskometer’s™ forward-thinking approach(backwards to me) has been widely praised by medical professionals. The app has been endorsed by the World Stroke Organization, World Federation of Neurology, European Stroke Organization, International Association on Neurology and Epidemiology and was recognised by HealthTap AppRX as the Top Medical Conditions App of 2014 as voted by doctors from more than 100,000 apps. “Stroke Riskometer is a great example of delivering research through the modern technologies of mobile health,” emphasises Kevin Pryor, Chief Executive Officer of AUT Enterprises.



    Holding a smart phone


    I got this because I'm trying to involve my affected hand more often. It works but takes me  5 minutes to get my fingers thru the loops. Then the problem becomes that my fingers will not lay flat and the thumb sticks over the top of the screen. Not very helpful when trying to play games or even just text. I haven't tried putting the phone up to my left ear with this because my arm will not stay in position there. 
    http://www.amazon.com/gp/product/B0073UGQSU/ref=oh_aui_detailpage_o00_s00?ie=UTF8&psc=1 
    Image result for WiseFinger Black - Smartphone Holder

    Newer contraceptive pills raise risk of blood clot four fold

    Be safe out there.
    http://www.telegraph.co.uk/news/science/science-news/11630581/Newer-contraceptive-pills-raise-risk-of-blood-clot-four-fold.html
    Taking third generation pills such as Yasmin, Femodene and Marvelon raises the chance of a blood clot four fold.

    More at link.

    Vinpocetine increases cerebral blood flow and oxygenation in stroke patients: a near infrared spectroscopy and transcranial Doppler study

    Only 13 years old so I wonder if this is in use anywhere. I had not heard of this before except it seems to help in middle ear infections. Acute or hyperacute?
    http://www.sciencedirect.com/science/article/pii/S092982660200006X
    Choose an option to locate/access this article:
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    Abstract

    Objective: To investigate the effect of vinpocetine on cerebral blood flow (CBF) in the compromised circulation of a stroke affected hemisphere using transcranial Doppler (TCD) and near infrared spectroscopy (NIRS) methods.  
    Methods: 43 patients with ischemic stroke were randomized into vinpocetine (VP) and placebo group in a double blind, placebo-controlled study of the effect of a single-dose i.v. infusion of vinpocetine on cerebral blood perfusion and oxygenation. In the VP group 20 mg VP in 500 ml saline, in the placebo group 500 ml saline alone were administered. The concentrations of oxy-, reduced- and total hemoglobin were measured by NIRS frontolaterally on the side of lesion while the mean cerebral blood flow velocity (CBFV), the pulsatility index (PI) and Doppler spectral intensity (DSI) were monitored by TCD in the middle cerebral artery on the same side. Values were averaged for the first 5 min prior to the infusion and for the last 5 min of infusion and they were compared between groups.  
    Results: The concentration of all three chromophores increased during infusion in the VP group (mean dHbT=1.03, CI95=0.84, P=0.058; mean dHbO=0.92, CI95=0.91, P=0.071; mean dHb=0.10, CI95=0.21, P=0.297). The HbT and HbO showed a substantially smaller increase in the placebo group (mean dHbT=0.31, CI95=0.74, P=0.22; mean dHbO=0.57, CI95=0.80, P=0.094) while the Hb decreased (mean dHb=−0.26, CI95=0.29, P=0.05). Comparing to the placebo group Hb increased significantly in the VP group (P=0.027) while the increase of HbO and HbT did not reach the level of significance (P=0.29 and 0.11). DSI showed a significantly larger increase in the VP than in placebo group (dDSI=25.8 CI95=8.8 [VP]; dDSI=3.3, CI95=3.7 [Placebo], P<0.005). The CBFV and PI did not differ significantly between groups. (dVm=5.0±2.98 cm/s [VP], dVm=4.1±2.57 cm/s [Placebo], P=0.28; dPI=0.08 [VP], dPI=0.09 [Placebo]; P=0.47).  
    Conclusion: VP increases cerebral perfusion and parenchymal oxygen extraction as well. The increased perfusion was indicated by NIRS and by TCD measurement of DSI while conventional velocity and pulsatility measurements failed to detect theses effects. NIRS is a sensitive, feasible method of measuring changes in regional blood flow and tissue oxygenation in the superficial cortex.

    Stroke Rounds: Novel Clot Buster Flops Again - desmoteplase

    I guess vampire bat saliva doesn't work that well. I would argue that the Rankin scale used to evaluate effectiveness is totally inappropriate. If you want to do this objectively you run daily MRI scans to see if the size of the dead area increases less with interventions vs. placebo. Still to be tested;
    1. liposome-encapsulated hemoglobin written in Feb. 2010
    2. bat saliva - Draculin  written in May, 2011, up to 9 hours OK, maybe a no go
    3. cardiac glycosides written in Feb. 2006 - up to 6 hours
    4.inhalation of nitric oxide written in March, 2012 - 48 hours to 7 days
    5. Nitric oxide written in 2006, to be tested in humans yet.
    6. xenon gas written in Feb. 2006, to be tested yet
    7. caffeinol irish coffee injection written in April 2003 to be tested in humans
    8. Docosahexaenoic acid (DHA), a component of fish oil written in Nov. 2010, up to 5 hours
    9. nicotine written in July 2005, to be tested in humans
    10. Viagra written in 2002, to be tested in humans,  for 7 days
    11.
    11. Enzogenol  written in Nov. 2011 for New Zealand
    12 edaravone approved in Japan since 2001
    13. nitroglycerin instructions
    14. benzodiazepine inverse agonist  written in Nov. 2010 

    http://www.medpagetoday.com/Cardiology/Strokes/51760?xid=nl_mpt_DHE_2015-05-27&eun=g424561d0r